men who have sex with men (MSM)
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Epidemiology
- incidence of unprotected sex on the rise 2008-2011[2]
Laboratory
- HIV1 testing annually
- Chlamydia DNA & Neisseria gonorrhoeae DNA*
* CDC recommends testing pharyngeal, urethral, & rectal sites for gonorrhea at least yearly in men who have sex with men if those sites of contact are exposed, based on individual sexual practices.
* the preferred screening method is nucleic acid amplification testing (NAAT) on a pharyngeal swab, a urine sample, & a rectal swab[5]
Complications
- HPV-16 & HPV-18 (etiologic agents of anal cancer) have low clearance rates & high incidence rates (despite antiretroviral therapy)
- 43% of U.S. black men who have sex with men will be diagnosed with HIV1 infection in their lifetime[3]
Management
- doxycycline 200-mg within 24 hours after condomless oral or anal sex (max 6 600 mg weekly) lowers risk for chlamydia & syphilis[4]
- tenofovir/emtricitabine as pre-exposure prophylaxis against HIV1 infection
- immunizations:
- hepatitis A vaccine (2 doses)
- hepatitis B vaccine[5]
References
- ↑ de Pokomandy A et al Prevalence, clearance, and incidence of anal human papillomavirus infection in HIV-infected men: The HIPVIRG Cohort Study. J Infect Dis 2009 Apr 1; 199:965. PMID: https://pubmed.ncbi.nlm.nih.gov/19239366
- ↑ 2.0 2.1 Centers for Disease Control and Prevention (CDC). HIV testing and risk behaviors among gay, bisexual and other men who have sex with men - United States. MMWR Morb Mortal Wkly Rep 2013 Nov 29; 62:958. <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/24280915 <Internet> http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6247a4.htm
- ↑ 3.0 3.1 Editors Physician's First Watch, Feb 24, 2016 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
- ↑ 4.0 4.1 Molina JM, Charreau I, Chidiac C et al Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open- label randomised substudy of the ANRS IPERGAY trial. Lancet Infectious Diseasees. Dec 8, 2017 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/29229440 <Internet> http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30725-9/fulltext
Fairley CK, Chow EPF Doxycycline post-exposure prophylaxis: let the debate begin. Lancet Infectious Diseasees. Dec 8, 2017 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/29229439 <Internet> http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30726-0/fulltext - ↑ 5.0 5.1 5.2 5.3 Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025